How can I help a service user who is constipated but refuses to take laxatives and eat the recommended diet?

Answered by Sheena Cunnington

Use a Person-Centred Approach:

• Check in with the person

Sometimes the service user may be refusing to take medicine or eat because they feel unwell: nauseated, bloated, in pain, uncomfortable etc. This may be caused by the constipation itself, or other factors may be at play.

Ask them how they are feeling; use active listening – watch their facial expressions, gestures, and tone of voice, as well as listening to the words they use.

• Explore perceptions and feelings

There may be an underlying fear or emotion behind a refusal to take dietary advice or laxatives. Gently ask questions to help uncover what’s behind the refusal.

You might say: ‘I understand being advised what foods to eat/taking laxatives isn’t something you enjoy. Can you tell me more about how you’re feeling?’

This may help the person feel heard and reduce resistance and defensiveness.

• Respecting Rights

This issue must be dealt with using a rights-based approach. The person has the right to choose the recommended diet or not and may choose not to take prescribed laxatives also. If they have the capacity to understand, educating them about the need for increased fluid intake (unless there are medical restrictions against this) and foods that will help is indicated.

• Service User Preferences

The standard advice is to increase fluid intake, and eat more wholegrain cereals, vegetables, and fruit – including the skins (wash first), if they’re edible. A healthy diet doesn’t have to be ‘rabbit food!’

Find out what the service user likes to eat and drink. Suggest prunes, prune juice, apples, broccoli, rhubarb, kiwifruit, dried fruits, liquorice, and carbonated water: these can all be effective in promoting regular bowel habit.

Soups, jelly, and ice cream are a good way to increase fluid intake.

A hot drink can be helpful. Most people defecate following the first meal of the day as a result of the gastrocolic reflex (contractions in the large intestine following food intake). Encourage the person to sit on the toilet and try to have a bowel movement shortly after meals.

• Coffee Time?

What is the service user’s favourite hot drink? There is anecdotal evidence suggesting that coffee is particularly effective.

• Get Moving

Encourage the person to be more physically active – even leg and arm raising from a chair can be of benefit.

• Breathe Deep!

Deep breathing techniques can help stomach muscles contract and relax to effectively move stool through the bowel.

• Don’t Delay

Advise not to delay bowel motions – encourage the person to visit the toilet when they feel an urge. (Remind them to avoid straining or forcing a motion as much as possible.)

A footstool placed in front of the toilet to raise the knees can be helpful in passing a motion, be mindful of trip hazards this may pose)

• Ask About Laxatives

Some laxatives are unappealing to take and may not meet the specific needs of the individual. Some commonly used types of laxatives are:

• Bulk forming laxatives – these are dietary fibre supplements which make the stool softer and easier to pass
• Osmotic laxatives – which draw water from the body into the bowel to soften the stool
• Softeners – help wet and soften the stool
• Stimulants – act on the muscles lining the gut, triggering the gut to contract and push out the stool

Ask the service user about the laxative that has been prescribed for them, do they find it difficult to take? Is it too great a volume, too sweet, or have an unpleasant taste?

Do they need support to seek advice from the GP or Pharmacist about ways to make it more palatable or to explore possible alternatives?